Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportancePhonosurgical treatments with photoangiolytic lasers, including blue light lasers, are increasingly common, yet effects on vocal fold oscillation patterns post-surgery are not fully understood.ObjectiveThe primary objective was to investigate changing oscillation patterns and recovery time of vocal fold oscillation after blue light laser phonosurgery in patients with unilateral vocal fold pathology.DesignProspective observational study following the STROBE guidelines, reporting pre- and post-intervention outcomes.SettingThe study was conducted in a clinical phonosurgical department specializing in vocal fold pathology.ParticipantsEight patients with unilateral vocal fold pathology were included. Eligibility was determined based on the necessity for phonosurgery.Intervention or ExposuresEach patient underwent phonosurgical treatment using a blue light laser. Vocal fold function was assessed preoperatively, 2 hours after surgery, 24 hours post-surgery, and 3 weeks following surgery. For the assessment, the subjects phonated on the vowel /i/ at a comfortable pitch and loudness.Main Outcome MeasuresHigh-speed videolaryngoscopy, electroglottography, and audio recordings were used to assess changes in vocal fold oscillations. Main metrics included amplitude symmetry index, jitter, cepstral peak prominence, and Open Quotients.ResultsTwo hours after surgery, an impairment in vocal fold oscillations on the treated side was observed, with a decrease in amplitude symmetry and an increase in electroglottographic jitter. Cepstral peak prominence was reduced, suggesting early effects on vocal fold vibration quality. By 24 hours and 3 weeks post-surgery, most parameters returned to preoperative values. However, the Open Quotient remained lower than pre-surgery levels at the 3-week follow-up, indicating a lasting change in glottal function.ConclusionsVocal fold oscillation recovers relatively quickly after blue light laser treatment, generally returning to baseline within 24 hours.RelevanceThis study highlights the temporary nature of vocal fold impairments following blue light laser surgery, providing insights for patient recovery expectations and voice rest recommendations.Clinical TrialGerman Clinical Trials Register, number DRKS00035411 https://www.drks.de/DRKS00035411.

ImportanceGlottal competence and cough effectiveness are associated with aspiration. In unilateral vocal fold paralysis (UVFP), injection laryngoplasty (IL) is the mainstay treatment for those with dysphonia and dysphagia. However, few data exist explaining how IL exerts its effects on aspiration prevention.ObjectiveTo evaluate the effect of IL on voluntary cough strength, glottal closure, and swallowing function. Furthermore, the effects were compared between patients with active treatment/disease and those without.Study DesignProspective cohort study.SettingLaryngology clinic of single tertiary hospital.ParticipantAdult patients underwent IL for UVFP between January 2021 and April 2023.Main Outcome MeasuresMaximum volitional cough pressure (MCoughP) was quantified before and after IL, as well as clinical voice outcomes and normalized glottal gap area. For those with a complaint of aspiration, the Eating Assessment Tool (EAT-10) questionnaire and Penetration-Aspiration Scale (PAS) were also evaluated.ResultsForty-one patients were included (26M:15F; age range 32 to 80 years old, mean age 58.7). Clinical voice outcomes and glottal closure were significantly improved in all patients, as well as EAT-10 score (16.22 ± 11.83 at pre-IL and 10.83 ± 11.17 at post-IL, P = .008) and PAS [2 (IQR 1.25, 2) at pre-IL and 1 (IQR 1, 2) at post-IL with 20 mL bolus, P = .02; 2 (IQR 2, 4) at pre-IL and 2 (IQR 1, 2) at post-IL with cup-sipping, P = .007]. Twelve patients had ongoing treatment/systemic diseases, who had significant improvement in voice and glottal closure but not in PAS. MCoughP was significantly increased in ongoing treatment/systemic diseases (-) group [42.90 ± 20.17 cmH₂O at pre-IL, 51.33 ± 21.15 at post-IL, 95% CI (-16.63, -0.23), P = .04] but decreased in ongoing treatment/systemic diseases (+) group [67.98 ± 40.06 cmH₂O at pre-IL, 55.32 ± 31.68 at post-IL, 95% CI (1.37, 23.97), P = .03].Conclusions and RelevanceIL significantly improved glottal competence and voice outcomes. However, increased volitional cough pressure and improved swallowing safety were only demonstrated in patients without ongoing treatment or systemic diseases. Patient's general condition may contribute to the observed effect of IL on dysphagia. Rehabilitation to optimize cough strength and prevent aspiration is beneficial for patients with deteriorating general conditions.

ImportanceHead and neck cancers (HNC) impose a significant economic burden on healthcare systems. Understanding the direct medical costs across different phases of care is crucial for resource allocation and cost-effectiveness evaluations, particularly in universal healthcare settings.ObjectiveTo quantify the direct medical costs of HNC over 60 months postdiagnosis and examine cost variations by cancer subsite, stage, and treatment modality.DesignPopulation-based, matched case-control study using administrative healthcare data.SettingOntario, Canada, a province with a publicly funded universal healthcare system.ParticipantsWe included 19,832 adults diagnosed with HNC between 2007 and 2020. Each case was matched with 5 noncancer controls based on age, sex, and comorbidity.ExposuresHNC diagnosis, categorized by cancer subsite, stage, and treatment modality.Main Outcome MeasuresMean per-person direct medical costs attributable to HNC over a 63-month period, analyzed by phase of care, cancer subsite, stage, and treatment modality.ResultsThe mean per-person cost attributable to HNC over 63 months was $53,812.9 ± $762.2. Costs peaked in the first 3 months postdiagnosis ($9709.7 ± $36.1 per month) and declined over time. Larynx/hypopharynx cancers incurred the highest costs across most phases. Advanced-stage cancers were associated with increased costs, with stage IV cancers nearly doubling the costs of stage I. Multimodal treatments, particularly surgery combined with chemoradiation, resulted in the highest costs across all phases (P < .01).ConclusionsHNC results in substantial healthcare costs, with significant variations by subsite, stage, and treatment modality. The highest costs occur in the early treatment phase and remain elevated for patients requiring multimodal therapies.RelevanceThese findings provide critical data for policymakers and health system authorities to optimize resource allocation and assess cost-effectiveness. Future research should explore indirect costs and the impact of early detection strategies to reduce the economic burden of HNC.Level of evidence3.

ImportanceBRAF V600E mutations are frequently associated with aggressive papillary thyroid carcinomas (PTCs), yet tumors with low allele frequency (AF) are often considered to be indolent. However, exceptions exist, suggesting additional factors may influence tumor behavior. Gene expression alterations (GEA) may help identify tumors with more aggressive molecular phenotypes.ObjectiveTo evaluate whether aggressive clinicopathologic features are associated with GEA positivity in low AF BRAF V600E-mutated PTCs.DesignRetrospective cohort study.SettingTwo McGill University Academic Hospitals, 2019 to 2024.ParticipantsPatients with PTC harboring BRAF V600E (AF ≤ 25%) who underwent preoperative testing.Intervention or ExposureLow AF BRAF V600E mutation (≤25%) characterized using ThyroSeq v3 genomic classifier.Main Outcome MeasuresThe primary outcome was GEA status. Tumor aggressiveness (defined by extrathyroidal extension, lymph node metastasis, lymphovascular invasion, high-risk histology, or aggressive variants), Bethesda classification, and AF were evaluated as predictors of GEA using logistic regression. Stratified analysis was performed based on AF (≤10% vs. >10%).ResultsAmong 49 patients identified (mean age 49 ± 14 years; 86% female; mean AF 11% ± 8%), 73% (36/49) had aggressive features and 61% (30/49) had GEA-positive tumors. Among GEA-positive tumors, 80% (24/30) were classified as aggressive and had a significantly-higher median AF (16.5%) than GEA-negative tumors (P = .0003). Stratified analysis showed that Bethesda VI nodules significantly predicted GEA positivity in tumors with AF > 10% (P = .03).ConclusionIn low AF BRAF V600E-mutated PTCs, GEA positivity is associated with high-risk cytology, higher AF, and aggressive tumor features.RelevanceGEA may be a useful molecular marker of aggressive tumor biology in low AF PTCs and holds potential as a complementary tool for preoperative risk stratification.

ImportanceDespite efforts to ensure equitable access to medically necessary services, disparities in care may persist in pediatric otolaryngology services.ObjectiveTo examine the relationship between socioeconomic marginalization and surgical wait times for tympanostomy tube insertion in the healthcare system of Ontario.Study designPopulation-based, retrospective cohort study utilizing administrative health data.SettingOntario, Canada.ParticipantsPatients ≤12 years who underwent bilateral tympanostomy tube insertion between 2010 and 2023 were included.ExposuresSocioeconomic marginalization measured by the Ontario Marginalization Index, rurality and immigrant status.Main Outcome MeasuresENT visit within 90 days of surgery, age at ENT visit, time from ENT visit to surgery, number of ENT visits during each year of follow-up, time to tympanostomy tube removal, and delayed tympanostomy tube removal (≥5 years post-surgery).ResultsA total of 76,574 tympanostomy tube patients were analyzed. As compared to the least marginalized patients, the most marginalized patients were significantly less likely to have an ENT visit within 90 days of surgery (75% vs 81.3%, P < .001). The number of emergency department visits (1: -15%, ≥2: -29%) was protective, decreasing age at ENT visit (P < .001). Furthermore, rural residence significantly increased the risk of higher age at ENT visit (+7%) (P < .001). Immigrant children were older at their final ENT visit and had longer surgical wait times compared to non-immigrant children (P < .001).ConclusionSignificant disparities exist in accessing tympanostomy tubes; socioeconomic marginalization, prior emergency department visits, sex, immigrant and rural status delaying the age at final ENT visit before surgery.RelevanceThese findings underscore the need for targeted strategies to improve equitable access to pediatric ENT services.

ImportanceThere are few studies comparing the various surgical approaches for the resection of parapharyngeal space tumors (PPSTs).ObjectiveTo compare surgical outcomes between transoral approaches (conventional transoral approach, endoscopic-assisted transoral approach, and transoral robotic surgery) and external approaches (EAs) in treating PPSTs.DesignSystematic review with meta-analysis.SettingEmbase, MEDLINE, CINAHL, Cochrane, and Web of Science databases were searched until August 2024. Findings were reported as per the PRISMA guidelines.ParticipantsAdult patients with PPST.InterventionsSurgical tumor resection using external or transoral approaches.Main Outcomes and MeasuresOverall effect size for primary outcomes (overall, neurological, non-neurological postoperative complications, and recurrence rates) was presented as event rate, while secondary outcomes (intraoperative bleeding, operation time, and hospitalization duration) were presented as mean differences (MDs).ResultsForty-eight studies involving 1728 patients with PPST were included. EAs were associated with higher incidences of overall [0.40 (0.32-0.48) vs 0.11 (0.08-0.15)] and neurological [0.30 (0.22-0.38) vs 0.05 (0.03-0.07); P < .0001] postoperative complications than transoral approaches (P < .0001 for both) with no significant difference in non-neurological complications. In addition, transoral approaches were associated with significantly fewer postoperative complications than EAs for benign [0.12 (0.22-0.35) vs 0.39 (0.29-0.48); P < .0001], malignant [0.17 (-0.08- 0.41) vs 0.63 (0.30-0.95); P = .03], and prestyloid [0.11 (0.06-0.17) vs 0.39 (0.22-0.05); P = .001] but not poststyloid tumors. Furthermore, transoral approaches were associated with significantly lower intraoperative blood loss (MD: -104.30 mL; P < .00001) and shorter hospitalization (MD: -1.70 days; P = .002) compared to EAs.ConclusionTransoral surgical approaches may be safe and feasible surgical treatments for selected patients, particularly in the prestyloid compartment, when performed in centers with expertise in advanced transoral surgery. Compared to EAs, these approaches had fewer postoperative neurological complications, less intraoperative bleeding, and shorter hospitalization.

ImportanceSingle-entry models (SEMs) can decrease wait times by placing patients in a common queue to see the first available physician. SEMs may be suitable to manage wait times in pediatric otolaryngology; however, understanding is lacking on stakeholder perceptions, and no previous studies have evaluated SEMs specifically for pediatric otolaryngology patients.ObjectiveTo evaluate the views of referring physicians and otolaryngologists on the role of SEMs in managing surgical backlogs for high-volume procedures, and to investigate their recommendations for optimal SEM design and implementation.DesignA qualitative study using semi-structured interviews (according to COREQ and SRQR guidelines).SettingPrimary care and referral settings across Ontario, Canada.ParticipantsTwelve referring physicians who refer to pediatric otolaryngologists and 11 otolaryngologists were recruited through purposive sampling. Eligibility criteria included physicians that work in Ontario.Intervention or ExposuresThis study investigated the perceptions of referring physicians and otolaryngologists on the concept of implementing SEMs for pediatric otolaryngology.Main Outcome MeasuresReferring physicians' and otolaryngologists' perceptions of SEMs as a method of managing wait times in pediatric otolaryngology.ResultsFour thematic domains, each with subdomains, were identified: (1) perceived value of SEMs; (2) operational design and digital integration; (3) evidence and resourcing; and (4) adoption, scope, and system pressures.ConclusionsSEMs are viewed as a viable option to address the surgical backlog in pediatric otolaryngology, from the perspective of referring physicians and otolaryngologists.RelevanceImplementation of an SEM should consider ease of use, adequate support resources, strong and regular communication with all stakeholders, long-term funding, and transparency.

ImportanceEfficient and accurate tools for early detection of hearing loss are essential for reducing delays in diagnosis and treatment.ObjectiveTo determine the accuracy and reliability of Automated iPad Hearing Screening (AIHS) as a screening tool compared to a formal pure tone audiometry (PTA).DesignA parallel cross-sectional study.SettingTertiary referral center in Hong Kong.ParticipantsSeventy-nine adult patients (158 ears) aged from 28 to 87 who were diagnosed with hearing loss were included.Exposure or InterventionParticipants underwent the AIHS screening at 1, 2, 4, and 0.5 kHz in the right and left ears, respectively, prior to a formal PTA, focusing solely on air conduction thresholds.Main Outcome MeasuresSensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) for detecting hearing loss at 3 thresholds: >25, >40, and >60 dBHL. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement between AIHS and PTA.ResultsExcellent sensitivity and specificity of the AHIS were identified across 3 age groups and different hearing levels. The AUCs of AHIS were .917 (95% CI: .842-.993), .911 (.863-.960), and .968 (.942-.994) for thresholds over 25, 40, and 60 dBHL, respectively. ICC = .901 (.864-.927) and Bland-Altman analysis indicated good agreement between these 2 methods.ConclusionThe AIHS is a simple, intuitive, and portable screening test for hearing loss that can be repeated with high accuracy and reliability at relatively low cost.

ImportancePeripheral blood inflammatory indices provide a noninvasive and cost-effective means to assess systemic inflammation. This study highlights the potential of pan-immune-inflammation value (PIV) as a reliable biomarker for obstructive sleep apnea (OSA) severity, with implications for clinical risk stratification.ObjectiveTo evaluate the association between peripheral blood inflammatory markers and OSA severity and identify predictive biomarkers for disease classification.DesignProspective observational study.SettingSingle tertiary academic medical center (Peking University Third Hospital), outpatient sleep clinic.Participants266 adults with snoring (18-70 years) undergoing sleep monitoring, laryngoscopy, and blood tests. Exclusion criteria included recent infection, systemic illness, surgery, or pregnancy.Intervention or ExposuresNo therapeutic intervention was performed. Exposures included varying severities of OSA and soft palate obstruction assessed by the Müller maneuver. Inflammatory indices (PIV, SIRI, SIL, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio [MLR], and platelet-to-lymphocyte ratio) were calculated from routine blood parameters.Main Outcome MeasuresThe primary outcome was the association between inflammatory indices and OSA severity as measured by apnea-hypopnea index (AHI). Secondary outcome was the correlation between inflammatory markers and soft palate-level obstruction.ResultsPIV and SIRI were significantly elevated in severe OSA cases (P = .001 and P = .012, respectively). PIV was independently associated with AHI severity (OR = 1.010, 95% CI [1.003, 1.017]). PIV and SIRI positively correlated with AHI (r = .236 and r = .218, both P < .001). MLR, PIV, and SIRI levels increased with greater soft palate collapse, though not independently predictive in multivariate analysis.ConclusionsPIV is an independent, accessible biomarker for assessing OSA severity. Composite indices (PIV, SIRI) may better reflect systemic inflammation than traditional single markers and could complement clinical phenotyping of OSA.RelevanceThese findings support the use of composite inflammatory indices in OSA phenotyping and prognosis. Future studies should investigate inflammation-targeted strategies and validate these biomarkers in larger, multicenter cohorts.Level of Evidence:3.

ImportanceHistopathological findings are important to guide our decision between cochlear and auditory brainstem implant in inner ear malformations (IEM) with cochlear hypoplasia (CH), incomplete partition (IP), and common cavity.ObjectiveCochlear implantation (CI) has variable outcome in IEM. Histopathology of IEM is evaluated to understand the causes of this variation.DesignEvaluation of human temporal bone specimens with IEM.ParticipantsTwenty temporal bone specimens from 10 donors who had IEMs were evaluated.Main outcome measuresClassification of IEM and analysis of cochlear morphology [inner and outer hair cells, spiral ganglion cells, and cochlear nerve (CN)] to understand the functional outcome of implantation.ResultsAmong the temporal bones with IEMs, 16 were classified as CH, 2 were IPs type II, and 2 had a normal cochlear anatomy, but absent CNs. The CN was hypoplastic in 3 specimens with CH-III. The nerve was lying adjacent to the bony wall, which would be difficult to demonstrate with current magnetic resonance imaging (MRI). The mean percentage of loss of spiral ganglion cells in CH-III among our specimens was 62%. Some specimens showed asymmetric development, which will play a crucial role in the benefit from CI. Two specimens from the same donor with a fully-developed cochlea demonstrated absent CN.ConclusionBetter MRI sequences are needed to demonstrate the hypoplastic CN adjacent to the wall of the internal auditory canal. Audiological examination is of paramount importance to demonstrate the presence of neural connection between the cochlea and the brainstem. In asymmetric developments between 2 sides, more developed side should be chosen for CI. Depending on the findings cochlear or auditory brainstem implants may be chosen for the contralateral findings. If there is only one implant available, the side with the better developed CN should be picked.